MEDICARE: PARKSIDE BEHAVIORAL HEALTHCARE ACQUISITION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283Q00000X	Psychiatric Hospital		OH

General Provider Information

NPI Number	:	1720011828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKSIDE BEHAVIORAL HEALTHCARE ACQUISITION INC

Provider Business Mailing Address
First Line	:	7074 GROVE RD STE 129
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-8658
Country	:	US
Telephone Number	:	523-597-5075
Fax Number	:

Provider Business Practice Location Address
First Line	:	349 OLDE RIDENOUR RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-2528
Country	:	US
Telephone Number	:	614-471-2552
Fax Number	:	614-471-0167

Authorized Official
Title or Position	:	CORPORATE DIRECTOR REVENUE CYCLE
Name	:	MS. TRACY ROBERTS
Credential	:
Telephone Number	:	423-895-0084

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/29/2025

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